Health care industry

Pricing medical services in the managed care environment

Article Abstract:

The portfolio approach to financial management in the managed care environment is necessary to determine sound prices for managed care contracts and to meet an organization's total financial requirements. Portfolio management, which permits differentiation of accounts to enable application of other management techniques to the payer mix, involves determining risk factors associated with pricing mechanisms to prevent contract losses. The importance of pairing utilization and pricing review in managed care contacts are discussed.

Insolvency in managed care organizations: financial indicators

Article Abstract:

Am examination of the financial history of health maintenance organizations (HMO) reveals the financial risks involved in the administration of managed care organizations. The risks which HMO's and other managed care organizations must address to prevent insolvency are presented and discussed. In addition, the indicators which determine financial solvency and by which HMO's can evaluate their financial strength and viability are presented.